Hong Kong Medical Journal最新文献

{"title":"Trends and outcomes of massive primary postpartum haemorrhage and second-line therapy use: a retrospective study in a Hong Kong public hospital using the Hospital Authority electronic audit form.","authors":"C K Wong, C M W Hung, W K Yung, A L L Chan, W L Lau, W C Leung","doi":"10.12809/hkmj2412211","DOIUrl":"10.12809/hkmj2412211","url":null,"abstract":"<p><strong>Introduction: </strong>Massive primary postpartum haemorrhage (PPH; blood loss ≥1500 mL within 24 hours after delivery) is a major cause of maternal morbidity and mortality in Hong Kong. We compared the incidence, management strategies, and maternal outcomes of massive primary PPH across two time periods at a single obstetric unit in Hong Kong.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with massive primary PPH at Kwong Wah Hospital between 2006 and 2011 (retrospectively identified) and between 2017 and 2022 (identified using the prospectively completed Hospital Authority electronic audit form). Maternal characteristics, causes of PPH, treatment modalities, and outcomes were analysed. Regression analyses examined associations between second-line therapies and blood loss or hysterectomy.</p><p><strong>Results: </strong>The incidence of massive primary PPH in our hospital increased from 0.27% to 0.44% (P<0.001). Use of second-line therapies also increased in the recent cohort (P<0.001). Furthermore, the recent cohort had a significantly lower median estimated blood loss than the earlier cohort (1700 mL [interquartile range (IQR), 1500-2000] vs 2000 mL [IQR, 1600-3000]), lower packed red blood cell transfusion requirements (2 [IQR, 1-4] vs 4 [IQR, 2-11] units), and a lower hysterectomy rate (2.2% vs 14.3%) [all P<0.001]. Regression analyses showed that second-line therapy was associated with greater blood loss overall; however, the excess blood loss associated with its use was substantially attenuated in the recent cohort.</p><p><strong>Conclusion: </strong>Despite the rising incidence of massive primary PPH in our hospital, maternal outcomes improved over time. These findings suggest that second-line and adjunctive medical therapies are used earlier and more frequently in contemporary practice.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"300-308"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated thyroglobulin due to a back musculature schwannoma in differentiated thyroid cancer: a case report.","authors":"T Wu, H Xu, X Zhao, X Su, H Wang, H Si","doi":"10.12809/hkmj2513221","DOIUrl":"10.12809/hkmj2513221","url":null,"abstract":"","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"365-366"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive prenatal screening as first-tier screening in Hong Kong public healthcare: a case for universal access.","authors":"O M Y Ngan, E C McKenzie, P P L So, W C Leung, M C S Wong","doi":"10.12809/hkmj265195","DOIUrl":"10.12809/hkmj265195","url":null,"abstract":"","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"287-290"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding e-learning in postgraduate medical education: system-level barriers and enablers in Hong Kong.","authors":"H Y So, A K M Chan, C T Lui, B C P Cheng, J Pun, C C Y Tham","doi":"10.12809/hkmj2514455","DOIUrl":"10.12809/hkmj2514455","url":null,"abstract":"<p><strong>Introduction: </strong>E-learning is increasingly central to postgraduate medical education (PGME), yet system-level barriers may hinder its integration. In Hong Kong, the Academy of Medicine (HKAM) has invested in a learning management system and faculty development, but uptake among Academy Colleges remains uneven. This study examined barriers and enablers across Colleges to inform system-level implementation.</p><p><strong>Methods: </strong>We used a sequential exploratory mixed-methods design. Phase 1 involved semi-structured interviews with one e-learning lead from each of the 13 participating Colleges, which were analysed thematically. Phase 2 comprised a survey of 266 education committee members, of whom 88 responded (33.1%). Items were rated on a five-point Likert scale (1=strongly disagree to 5=strongly agree), with optional free-text comments.</p><p><strong>Results: </strong>Five themes emerged, namely, (1) limited strategic urgency; (2) gaps in faculty capability and trainee readiness; (3) weak system enablers; (4) lack of recognition and resources; and (5) the need for system-level strategies. The survey corroborated these findings, with the lowest ratings for information technology (IT) support and incentives and the highest for a clear HKAM policy (mean, 4.20) and inter-College benchmarking (mean, 4.01). System enablers received the lowest overall score (mean, 2.89); recognition and resource allocation also scored poorly (mean, 2.87). Strategic buy-in was moderate (mean, 3.53), highlighting a contrast between strong demand for central direction and limited operational support.</p><p><strong>Conclusion: </strong>Sustainable PGME e-learning requires integrated action across motivation, capability, and opportunity. Leadership signalling and recognition are needed to strengthen motivation; tiered faculty development and trainee orientation to build capability; and coordinated IT support, workflow integration, and resource sharing to expand opportunity.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"322-329"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From estate doctor to the frontier of family medicine in Hong Kong: Dr Stephen Kam-so Foo.","authors":"L M H Li, D H Y Lee","doi":"10.12809/hkmj-hc202608","DOIUrl":"https://doi.org/10.12809/hkmj-hc202608","url":null,"abstract":"","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":"32 4","pages":"375-377"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary leiomyomatosis and renal cell carcinoma: a case series.","authors":"C W L Cheung, J Y Y Poon, C W M Au, J H Y Ng, T H T Cheng, H M Luk","doi":"10.12809/hkmj2513770","DOIUrl":"10.12809/hkmj2513770","url":null,"abstract":"","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"359-361"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excision of giant orbital arteriovenous malformation combined with ligation of the external carotid artery: a case report.","authors":"J Liu, J Zhao, J Hong, T Lin, L Zhu","doi":"10.12809/hkmj2513077","DOIUrl":"10.12809/hkmj2513077","url":null,"abstract":"","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"357-358"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetist-led perioperative transthoracic echocardiography service: a clinical audit.","authors":"C F Yim, K C Tse","doi":"10.12809/hkmj2513782","DOIUrl":"https://doi.org/10.12809/hkmj2513782","url":null,"abstract":"<p><strong>Introduction: </strong>Growing enthusiasm for transthoracic echocardiography (TTE) among non-cardiac specialties has led to the development of multiple focused TTE protocols in recent years. The role of echocardiography in anaesthesiology is also evolving; an increasing number of anaesthetic units in Hong Kong have established or devised anaesthetist-led TTE services to fast-track patients who require focused TTE in the perioperative period. This study explored the clinical impact of anaesthetist-led perioperative TTE on the perioperative management of patients undergoing non-cardiac surgery in Hong Kong.</p><p><strong>Methods: </strong>A retrospective study was conducted in a single-centre anaesthetic unit in Hong Kong. Data from November 2019 to October 2024 were obtained for adult patients undergoing non-cardiac surgery who received TTE performed by anaesthetists and TTE performed or interpreted by cardiologists. Four perioperatively significant parameters were compared, including agreement on left ventricular ejection fraction (LVEF), tricuspid regurgitation pressure gradient, and the presence of aortic or mitral stenosis. Cohen's kappa analysis was used to measure interobserver agreement for binary/categorical variables (eg, presence of valve pathology); Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to measure agreement for continuous variables.</p><p><strong>Results: </strong>In total, 405 patients were identified, of whom 34 were included. Cohen's kappa values were 1 (P<0.001) for diagnosing mitral stenosis and 0.87 (P<0.001) for diagnosing aortic stenosis. The ICC for LVEF was 0.61 (95% confidence interval [95% CI]=0.35-0.78; P<0.001). The ICC for tricuspid regurgitation pressure gradient was 0.7 (95% CI=0.41-0.86; P<0.001).</p><p><strong>Conclusion: </strong>The results show reasonable agreement between anaesthetist-performed echocardiograms and the 'gold standard' across all four perioperatively significant parameters.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":"32 4","pages":"317-321"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term risk factor analysis and predictors of restenosis in patients undergoing carotid artery stenting.","authors":"R Y T Chow, Y C Chan, A C W Ting, G C Cheung, S W K Cheng","doi":"10.12809/hkmj2513757","DOIUrl":"10.12809/hkmj2513757","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the timing and risk factors of restenosis (≥50% stenosis) in patients undergoing carotid artery stenting (CAS).</p><p><strong>Methods: </strong>This retrospective case series included patients who underwent CAS between January 2007 and December 2022 at a tertiary referral vascular centre in Hong Kong. Patient demographics, co-morbidities, operative details, and clinical and radiological surveillance findings were reviewed. Univariate and multivariable Cox regression analyses were performed.</p><p><strong>Results: </strong>In total, 120 CAS procedures (13 bilateral) were performed in 102 patients. Overall, 80% of patients were male (mean age: 66.9 years), and 45 (37.5%) were symptomatic preoperatively. The mean follow-up duration was 6.7 ± 4.2 years. Post-procedure, ipsilateral stroke occurred in 10 (8.3%) cases; the stroke-related mortality rate was 2.5%. In all, 51 (46.4%) of 110 evaluable cases developed restenosis, of which 29 (26.3%) occurred within 1 year postoperatively. The mean time to ≥50% restenosis development was 94.9 months. Univariate Cox regression analysis showed that a history of nasopharyngeal carcinoma (hazard ratio [HR]=2.12; P=0.01) and previous neck radiotherapy (HR=2.96; P<0.001) were significantly associated with higher restenosis risk. A greater number of stents, longer stent length, and post-dilation balloon diameter >5.5 mm (all P<0.001) were linked to higher restenosis risk. In multivariable Cox regression analysis, a history of radiotherapy (HR=3.72; P=0.01) and larger post-dilation balloon diameter (HR=2.10; P=0.01) remained associated with higher restenosis risk.</p><p><strong>Conclusion: </strong>The 12-month restenosis rate was 26.3%, although restenosis rarely caused new neurological events. A history of radiotherapy and larger post-dilation balloon diameter were associated with higher restenosis risk.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"309-316"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-stop virtual planning for optimising implant selection and surgical efficiency in subtrochanteric fractures.","authors":"K Zhang, M Qiang, G Jia, X Jia, Z Yang, T Shi, Q Han, T Liu, Y Chen","doi":"10.12809/hkmj2514064","DOIUrl":"10.12809/hkmj2514064","url":null,"abstract":"<p><strong>Introduction: </strong>Long proximal femoral intramedullary nails present challenges in the treatment of subtrochanteric fractures. Short nails may represent a suitable alternative; however, conventional preoperative planning has limitations in evaluating their appropriateness. This study investigated whether computer-assisted virtual planning can enhance implant selection consistency, short nail utilisation, and surgical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 103 patients (57 virtual planning, 46 conventional planning) treated with proximal femoral intramedullary nailing at a Level I trauma centre in China between 2009 and 2018. Conventional planning relied on imaging and surgeon experience. Virtual planning used three-dimensional computed tomography reconstruction to simulate fracture reduction and determine optimal implant dimensions. Primary outcomes were the planned and actual implant dimensions selected. Secondary outcomes included operative parameters, complications, implant-associated adverse events, and functional scores at 12 months. Robust multivariate analysis of covariance and logistic regression analyses were performed.</p><p><strong>Results: </strong>Compared with conventional planning, virtual planning demonstrated higher consistency between planned and actual short/long nail selection (kappa coefficient=0.95 vs 0.54) and implant dimensions (intraclass correlation coefficient=0.889-0.971 vs 0.786-0.870), with a higher actual short nail utilisation rate (75.4% vs 52.2%). Virtual planning reduced operative duration (90.21 vs 141.67 minutes; P<0.001), closed reduction duration (23.02 vs 30.43 minutes; P<0.001), blood loss (203.51 vs 294.78 mL; P<0.001), and number of fluoroscopy exposures (19.95 vs 29.67; P<0.001), and was associated with faster learning curves. Complications and functional scores were statistically similar between groups but numerically favoured the virtual planning group.</p><p><strong>Conclusion: </strong>Virtual planning improved implant selection consistency, short nail utilisation, and surgical efficiency. It demonstrated numerically superior clinical outcomes.</p>","PeriodicalId":48828,"journal":{"name":"Hong Kong Medical Journal","volume":" ","pages":"341-349"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}